We report the development of an acquired nevus flammeus following a ski accident. This disorder was first described by Fegeler 1949, who reported the case of a 43-year-old soldier who acquired a nevus flammeus in the face following a cranial trauma. Since then, a number of similar case reports have been published. Differential diagnosis is discussed, such as the unilateral nevoid teleangiectasia syndrome, eruptive nevoid teleangiectasia and eruptive spider nevi.
The complaint "Doctor, I am losing my hair" represents a particular challenge to the physician, and involves making a specific diagnosis, selecting an appropriate therapy, and expressing empathy for the patient's anxiety. Diffuse hair loss in women was formerly classified as an entity of its own. Since the identification of female pattern hair loss, most cases have been recognized to be due to androgenetic alopecia, often during phases of life characterized by fluctuations of sexual hormone levels or in connection with intake or cessation of hormonal therapy. The most difficult differential diagnosis includes androgenetic alopecia, chronic telogen effluvium, and psychogenic pseudo efflvuium. Androgenetic alopecia is due to androgen-induced, non-synchronized, progressive shortening of the hair growth cycle and gradually leads to thinning of the central scalp area. Idiopathic chronic telogen effluvium typically occurs in women, starting abruptly without a recognizable initiating factor, and involves the entire scalp area with increased shedding of telogen hair. It is believed to be due to synchronization phenomena of the cyclic hair growth. Psychogenic pseudo effluvium affects fashion-oriented, self-conscious women suffering of a discrepancy between the actual state of their hair and idealized expectations. Later the problem of age-related hair thinning oft becomes a surrogate for the more generalized problem of senescence. Rational therapy of androgenetic alopecia aims at blocking the androgen effect on hair follicles with estrogens and antiandrogens or at pharmacologically reversing vellus hair transformation with topical minoxidil. In contrast, women with idiopathic chronic telogen effluvium should be reassured that their problem is rather a state of exaggerated "hair shedding" than of actual "hair loss".
Following BCG vaccination, local or systemic complications may occur. A 19-year-old female patient with negative tuberculin skin test developed a blister evolving over two weeks into an ulcer in a vaccination site on the left hip. Ulcerations following BCG vaccination are rare and show a tendency to chronicity. The treatment recommendations are controversial and range from non-specific topical treatment to systemic tuberculostatic therapy. In this case, the ulcer cleared rapidly after topical treatment with INH powder.
Anti-aging medicine is dedicated to the advancement of technology to detect, prevent, and treat aging related disease and to promote research into methods to retard and optimize the aging process. Dermatology offers good basics for rational preventive and therapeutic anti-aging strategies. The role of the skin in anti-aging medicine is not merely that aging is most obvious on the skin, but that the skin is a highly accessible and unique organ that offers unequaled opportunities to the gerontologist for the study of age-related effects. The study of skin aging focuses on two main streams of interest: On one hand, the esthetic problem and its management; on the other, the biological problem of aging in terms of microscopic, biochemical, and molecular changes. Probably the same molecular mechanisms underlying the aging of skin and its appendages, including the pigmentary system, underlie age-dependent degenerative changes of the inner organs and entire organism. The skin and hair are subject to intrinsic or physiologic aging, and extrinsic or premature aging due to external factors. Intrinsic factors are related to individual genetic and epigenetic mechanisms with interindividual variation. Extrinsic factors include ultraviolet radiation and cigarette smoking. Primary prevention encompasses measures that are taken before the aging process has started, secondary prevention when the first signs of aging have come into sight. Eventually, tertiary measures are aimed at correcting established signs of aging. Prevention starts with photoprotection and avoidance of cigarette smoking. In dermatologic practice sun protecting agents, dermocosmetic substances, hair growth promoting agents, and anti-aging compounds play an ever increasing role. Finally, tertiary anti-aging measures include minimally invasive cosmetic procedures such as chemical peels, microdermabrasion, soft tissue fillers, non-ablative laser rejuvenation, radiofrequency techniques and botulinum toxin, as well as laser skin resurfacing and corrective surgical procedures, including autologous hair transplantation.
Dermatology and internal medicine have in common that many systemic diseases manifest with skin symptoms that are easily accessible for both diagnostic and investigative procedures. Even if modern practice of medicine tends towards organ specific particularity of specialists, dermatology traditionally strives for interdisciplinary communication. Cutaneous manifestations of internal diseases present in various forms. In a syndrome, a number of symptoms present in an identical pattern, and pattern recognition is diagnostic. Vice versa, a distinct skin sign can be a clue to various internal disorders, that have to be considered in the differential diagnosis. Purpura and livedo due to either inflammatory (immune complex mediated or associated with ANCA) or vasoocclusive microthrombotic vascular disease are presented as examples. Finally, subtile variations in key symptoms of the skin, such as of pyoderma gangrenosum, may give a clue to a specific underlying disease, such as rheumatoid arthritis, inflammatory bowel disease, monoclonal gammopathy, or hematologic disease, as exemplified by the variants of pyoderma gangrenosum.
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